Provider Demographics
NPI:1760492672
Name:PA ARTIFICIAL LIMB & BRACE CO., INC
Entity Type:Organization
Organization Name:PA ARTIFICIAL LIMB & BRACE CO., INC
Other - Org Name:ARTIFICIAL LIMB & BRACE OF ASHTABULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-868-5231
Mailing Address - Street 1:224 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1806
Mailing Address - Country:US
Mailing Address - Phone:814-868-5231
Mailing Address - Fax:814-868-5232
Practice Address - Street 1:4859 N RIDGE W
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9409
Practice Address - Country:US
Practice Address - Phone:440-969-1144
Practice Address - Fax:814-868-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OHLPO-294335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342212Medicaid
OH287952OtherHIGHMARK
OH8675613OtherCIGNA
ND219593OtherUPMC
OH000000154842OtherANTHEM
ND219593OtherUPMC
OH8675613OtherCIGNA
OH0249590002Medicare ID - Type Unspecified